Healthcare Provider Details

I. General information

NPI: 1548715246
Provider Name (Legal Business Name): ALICIA ASH MA, EDS, NCSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALICIA JACOBS

II. Dates (important events)

Enumeration Date: 08/23/2016
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 GATEWAY CIR UNIT 3
ST JOHNS FL
32259-4085
US

IV. Provider business mailing address

94 LOMOND CT
ST AUGUSTINE FL
32095-7571
US

V. Phone/Fax

Practice location:
  • Phone: 773-870-2377
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSS1577
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1817988
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: